颞骨切除及皮瓣重建后颅底骨髓炎（坏死性外耳道炎）

文献信息

中文摘要

坏死性外耳道炎（NOE）是一种累及颅底的危及生命的外耳道感染。我们报告一例具有NOE样特征的Citrobacter koseri颅底骨髓炎，在颅底手术后三个月出现。一名69岁男性因广泛基底细胞癌接受了左侧颞骨外侧切除术及耳廓切除术，并采用胸背动脉穿支皮瓣重建。间隔计算机断层扫描和磁共振成像显示皮瓣深部强化，累及颅底和鼻咽部，引起对复发的担忧。鼻后间隙活检排除了恶性肿瘤，但培养分离出C. koseri。经过多学科评估，诊断为NOE，并开始口服复方磺胺甲噁唑，临床和影像学均有改善。本病例突出了复杂颅底重建术后感染诊断的挑战。

英文摘要

Necrotising otitis externa (NOE) is a life-threatening infection of the external auditory canal with skull base involvement. We report a case of Citrobacter koseri skull base osteomyelitis with NOE-like features, presenting three months following skull base surgery. A 69-year-old man underwent a left lateral temporal bone resection and pinnectomy with thoracodorsal artery perforator flap reconstruction for extensive basal cell carcinoma. Interval computed tomography and magnetic resonance imaging demonstrated enhancement deep to the flap with skull base and nasopharyngeal involvement, raising concern for recurrence. A postnasal space biopsy excluded malignancy, but cultures isolated C. koseri. Following multidisciplinary review, NOE was diagnosed, and oral cotrimoxazole was initiated, with clinical and radiological improvement. This case highlights the challenges in diagnosing postoperative infection after complex skull-base reconstruction.